Neurosurgery
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When using the median infratentorial supracerebellar approach, all or numerous bridging veins over the cerebellar surface must be sacrificed. Such sacrifice potentially causes cerebellar venous infarction, especially when excessive cerebellar retraction is applied. To prevent such potential complications, neurosurgeons must have adequate knowledge of the anatomy of the bridging veins, particularly the hemispheric bridging veins. ⋯ Anatomic familiarity with the bridging veins can minimize their intraoperative sacrifice and avert subsequent postoperative complications. This knowledge also assists in planning the best approach to the pineal region.
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To evaluate the surgical findings and subsequent therapeutic implications of posterior fossa reexploration for persistent or recurrent trigeminal neuralgia (TN) or hemifacial spasm (HFS) after failed microvascular decompression (MVD). ⋯ Recurrent vascular compression was seldom identified during posterior fossa reexploration for failed MVD in patients with persistent or recurrent TN or HFS. The previously placed Ivalon sponge or Teflon implant was consistently found to be in good position. Partial sensory trigeminal rhizotomy is an often effective alternative in cases of recurrent TN when neurovascular compression is not identified. However, because of the relatively high incidence of complications associated with reexploration, we recommend other ablative or medical treatments for most patients after failed MVD for TN or HFS.
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Trigeminal neuralgia (TGN) is generally a disease of the elderly. Vascular compression, the causative agent in the majority of cases, is thought to result from atherosclerotic changes within the vessels of the posterior fossa. Rarely, the disease presents during childhood, before the onset of severe atherosclerotic changes. We therefore sought to explore the role of vascular compression in pediatric patients with medically refractory TGN. ⋯ MVD has been demonstrated to be a safe and efficacious treatment for TGN in the adult population. Patients whose symptoms begin in childhood do not enjoy the same therapeutic response to MVD as do patients with TGN onset in adulthood. An increased incidence of venous compression was noted in this population, as was a longer duration of symptoms before MVD. These factors may be responsible for the decreased efficacy of MVD in this patient population.
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Biography Historical Article
Library: historical perspective. Herbert Olivecrona (1891-1980)